Hyperbaric Oxygen Therapy in Wound Care: Indications and Evidence

HBOT is the inhalation of 100% oxygen in a chamber pressurised to 2–3 atmospheres, dramatically increasing dissolved plasma oxygen and tissue oxygen delivery to ischaemic regions.

UHMS-accepted indications (selected)

1. Wagner ≥3 diabetic foot ulcer non-responsive to 30 days of standard care
2. Soft-tissue radionecrosis and osteoradionecrosis
3. Threatened skin grafts
4. Necrotising soft-tissue infections (adjunct)
5. Refractory chronic osteomyelitis
6. Crush injury

Evidence in DFU

Cochrane (Kranke 2015) suggests HBOT increases short-term DFU healing in Wagner ≥3, but DAMO2CLES (2018) found no significant benefit in ischaemic DFU — patient selection is critical.

Contraindications and side-effects

• Untreated pneumothorax — absolute
• Severe COPD — caution
• Common: ear barotrauma, transient myopia, claustrophobia
• Rare: oxygen toxicity seizure

References

1. Kranke P, et al. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database Syst Rev. 2015;(6):CD004123. https://doi.org/10.1002/14651858.CD004123.pub4
2. Santema KTB, et al. DAMO2CLES trial. Diabetes Care. 2018;41(1):112–119. https://doi.org/10.2337/dc17-0654
3. Löndahl M, et al. HBOT for chronic foot ulcers in diabetes. Diabetes Care. 2010;33(5):998–1003. https://doi.org/10.2337/dc09-1754